11D2205615 CLIA NUMBER - WALGREENS #10854

Laboratory Demographics

  • CLIA Code: 11D2205615
  • Facility Name: WALGREENS #10854
  • Facility Address: 2701 FAIRBURN ROAD
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: 404 556-6536
  • Facility Type: Other - COVID TEST SITE
  • Facility Type: Waiver
  • Lab Director: SIMY CASASOLA
  • NPI Number: 1023266921
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2205615
LAB Type Other - COVID TEST SITE
Facility Name WALGREENS #10854
Street 2701 FAIRBURN ROAD
City DOUGLASVILLE
State GA
ZIP 30135
Phone 404 556-6536
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Other - COVID TEST SITE
Lab Director SIMY CASASOLA

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This page was last updated on: 9/29/2025